Anyone attending the recent American Academy of Ophthalmology or pre-AAO International Society of Refractive Surgery meeting will appreciate the role laser in situ keratomileusis is beginning to have in the armamentarium of the modern-day refractive surgeon. As more and more surgeons embark on performing lamellar refractive surgery, complications during the learning curve are inevitable. Here are a few tips for the beginning LASIK surgeon.

2. Use a closed-blade speculum to help keep the lashes out of the way, especially if you don't drape or tape the lids.

3. Reflect the cap with a 26G cannula

4. Decenter the flap nasally to help ensure the hinge is not ablated.

5. Decenter the flap inferiorly slightly if there is significant superior corneal neovascularization.

6. When suction is applied and the keratome is engaged in the tracks, apply moderate downward (posterior) pressure with the suction ring handle, so that in the rare event suction is lost, the keratectomy will still be flawless.

7. If the laser being used has variable magnification, go to a less powerful zoom when doing the keratectomy.

8. Prior to applying the suction, warn the patient that the fixation light might go out. Fear of losing vision ranks high in the patient" mind, and when the light goes out they will panic, thinking they've gone blind, unless they've been appropriately forewarned.

9. As with photorefractive keratectomy, continuously talk to the patient throughout the keratectomy and the laser ablation. Let them know everything is going fine, and they will be more relaxed and cooperative

10. With the Visx Star laser, turn down the ring illumination and turn up the oblique halogen lights to enable better patient fixation, and better illumination of the pupil through the stroma bed. This will improve centration.

11. Most importantly, when first starting LASIK, be conservative with your ablations. Regardless of what other surgeons tell you about their experience on their laser, start off by backing down on your intended amount of correction. It is very easy to retreat an undercorrection. With more personal experience on your own laser, you may begin to "push the envelope" and get more aggressive with your corrections.

Hopefully these tips will help make LASIK easier to master. When properly performed, LASIK will usually create an ecstatic patient and a proud surgeon.